Runner's Knee

Patelleo-Femoral Pain Syndrome / Runner's Knee Treatment in Adelaide

The Resilient Knee Project is an innovative solution for people with chronic knee pain that empowers individuals to self-manage their pain and most importantly, get them back to enjoy the physical and mental benefits of running.

Founded by Daniel O’Grady, dedicated professional with first hand experience of overcoming knee pain and running the NYC Marathon, the project aims to be a world leader in restoring people’s confidence in their knees and get back to doing what they love.

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What is Runners Knee (Patellofemoral Pain PFP)?

Patellofemoral pain (PFP) is a common condition where pain is felt on the front of the knee, either around or behind the patella.

It occurs in up to 20% of the population (1).

The patellofemoral joint is made of the kneecap (patella) sitting on the front of the thigh bone.

The patellofemoral joint functions as a pulley system to help the quadriceps muscles straighten the knee most efficiently.

There are around 20 muscles that hold the patella centred and aligned.

Pain often results when there is excessive compression on the patella or a muscle imbalance around the patella causes misalignment of the patella.

Over time, this causes rubbing of the joint surfaces, creating inflammation and pain.

What are the most common symptoms of PFP?

• general ache/pain in the front of the knee

• pain aggravated activity involving a bent knee and body weight on the leg (e.g. walking up and down stairs, squatting, kneeling, jumping or hopping)

• pain aggravated by sitting for prolonged periods e.g. driving or sitting in a movie theatre.

• some people also hear and feel a grinding / clicking around the knee with mild swelling

An x-ray or MRI is not usually necessary to diagnose PFP.

Patello-femoral pain is often mis-diagnosed as knee osteo-arthritis in young people, due to the deep ache that is often felt. 

An assessment by a Physiotherapist will help to clarify your diagnosis.

Who is most likely to be affected by PFP?

The main risk factor for developing PFP is recent spike in training load. 

PFP is common in:

• runners

• cyclists

• triathletes

• cross fitters

• football, basketball, jumping sports

• hikers (especially going downhill)

Biomechanical issues that can predispose to PFP include:

• weakness in glutes, quads (VMO), core, calves

• tight ITB, TFL, quads (outer), hamstrings, calves

• stiffness in ankles (e.g. post ankle sprain)

• stiffness in the hip joints / hip flexors

• runners with who predominantly heel strike

 White et al (2009) showed that patients with patellofemoral pain had shorter hamstring muscles than asymptomatic controls.

What is the most effective treatment?

There is strong evidence to support a tailored physiotherapy (including exercise, education, taping), compared to placebo in the short (six weeks) and long-term (one year).

Evidence shows a personalised exercise program (combination of stretching and strengthening) gives the best long term outcomes. 

Ideally this exercise program is set up by a Physiotherapist after a comprehensive assessment. 

How long until I feel better?

As our understanding has grown, it has become clear that PFP is not necessarily something that will disappear on its own, and some people can have episodes on and off for many years.

As such, in order to have the best chance of recovering from your PFP and reducing the likelihood of it recurring, it is important to understand your condition, your individual contributing factors and what you can do.

For many people, a program of ongoing and progressive exercise (as prescribed by your physiotherapist) is necessary to build and maintain muscle strength, and good movement coordination.

Additionally, there is evidence suggesting that people with PFP may have an increased risk of going on to develop patellofemoral osteoarthritis (OA). Therefore, seeing an experienced physiotherapist for a management program will help you keep your patellofemoral joints functioning as well as possible, and keep you as active as you’d like to be now and into the future.

What can I do?

• avoid aggravating activities

• ice your knee to eliminate the inflammation (15 mins x 2 day for 2 weeks)

• home exercises - foam rolling (see below) and strengthening

For Runners:

• avoid hills

• cut back on your running mileage

• increase your cadence by 5-10%

• check your shoes - time for a new pair?

• focus on cross training - swimming, pilates, yoga e.t.c.

Some of the common foam roller exercises we prescribe:

Calf

Hamstring

ITB

Quads

How can a Physiotherapist assist with recovery?

1.  Assessment and Diagnosis

A Physio Assessment early on  in your journey pays big dividends in terms of identifying relevant contributing factors and helping you get on the fast track to healing. 

We spend a lot of time in the beginning educating you so you know what to expect in terms of recovery and what you need to do, to manage your recovery successfully.

2.  Dry Needling / Massage and Taping

Generally a short burst of targeted hands manual therapy over 3-4 sessions will help re-set your tissues, balance the muscles around the knee and get you into a position where you can confidently self-manage. 

Muscles that are commonly tight and affecting your knee include:

• ITB

• TFL

• hamstrings

• quads and calves

Foam rolling and spiky ball massage are effective at maintaining flexibility, but dry needling has the ability to get to the deeper part of the muscle and get a more effective release. 

Find out more about dry needling here.

We can also show you how to tape your knee to provide relief in the short-term.

3.  Guidance on load management

We will give you advice on how to gradually re-load your tissues to safely protect your knee from future flare-ups.  We work with your coach or trainer to manage your return to doing what you love. 

4.  Building a personalised home exercise program

You are the most important part of the healing process and what you do is the most important part getting you better. 

We use the convenient Physitrack App to build your personalised home program with videos delivered to your smart phone.

5.  Movement Re-Training

Once your pain is under control we then watch how you move and optimise your movement patterning to decrease the chances of the knee pain returning.

People with patello-femoral pain are often hip flexor and quadricep dominant and need to learn how to activate the glutes and hamstrings.

We have some specific exercises to show you to help you fast track this process.

Is Knee Pain or Injury keeping you from being as active and healthy as you want?

Don't delay your treatment...

The occasional ache or pain may be nothing to worry about, but failing to pay attention to strong pain may end up causing you a lot of problems in the future. If knee pain is reducing your ability to take part in the activities your normally do, then it is time to get it looked at. In general, chronic knee pain or clicking that is affecting your life is a sign that something is wrong.

A serious problem will not correct itself, and left untreated, can result in more pain and irreversible damage. 

Bookings:

If you think we are the right fit for you and you wish to get relief right away, use our simple online booking system to make an appointment.  If you would prefer to speak to us directly,  call us 1300 657 813

References:

1.  Boling M, Padua D, Marshall S, et al. Gender differ- ences in the incidence and prevalence of patellofe- moral pain syndrome. Scand J Med Sci Sports 2010;20(5):725–30.

2. 

Wood L, Muller S, Peat G. The epidemiology of patellofemoral disorders in adulthood: A review of routine general practice morbidity recording. Prim Health Care Res Dev 2011;12(2):157–64.

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Dan O'Grady is a results driven qualified Physiotherapist and member of the Australian Physiotherapy Association.  Dan has a special interest in treating knee pain.  He has been working in private practice for 15 years with (over 20,000 patient consults). He is passionate about helping people to move better, feel better and get back to doing what they love.

Other blogs to help with your knee pain and get your performing at your best:

Tendinopathy Update

The past weekend I attended Peter Malliaras's course, 'Mastering Lower Limb Tendinopathies'.

Peter is an Associate Professor at Monash University and has spent many years researching and working with people with tendon problems. 

In recent years there has been a lot of significant new research in the world of tendon rehab.

If you've ever had an issue with an ongoing tendon problem, you can understand how frustrating the long term pain and dysfunction can be. 

There is much conflicting advice and out dated treatment approaches that can contribute to the poor outcomes many people face with tendon injuries. 

Thankfully, Peter has put all of the latest based evidence into a comprehensible format and in this blog post I'd like to share just a little summary.

This blog would be particularly helpful if you suffer from ongoing pain in the:

• Achilles tendon

• Hamstring

• Patella tendon

• Hip pain/bursitis

• Plantar fascia

What is a tendon?

Tendons connect the muscle to bone.  They are made up primarily of collagen fibres.

In the lower limb, role of tendon is to absorb and release energy

Tendons are like springs that absorb stretching forces and then release energy when we move.

What causes tendon problems?

Tendons are very sensitive to changes in load. 

Essentially, tendons become injured when we over-load them too soon, or when demand exceeds capacity.

This can be from:

• too much volume

• too much intensity

• change in footwear or surface

For example a runner may start to include sprinting or hill work too soon or increase mileage suddenly leading up to a big race.

High training load is not a risk for injuries, it's how you get there that is the important factor (i.e. avoiding acute spikes in training loads).

                   Tendons become damaged when demand exceeds their capacity

What is the difference between Tendinitis and Tendinopathy?

Tendinitis refers to the inflammation in the early stages of an injury. 

This is opposed to tendinopathy that refers to the process of degeneration that tendon goes through in response to chronic overload.

Recent research suggests a lot of what we previously thought of as tendon inflammation was actually related to tendinopathy.

Who is likely to suffer from a tendon problem?

Patella tendon (front of knee)

Usually occurs in younger people involved in jumping sports such as volleyball, basketball and football.  There is some evidence to suggest pathological tendon changes can begin in early adolescence if there excess load on the maturing collagen in the tendon.

Achilles tendon (back of heel)

Affects people across the lifespan, in particular long distance runners, sprinters, football and soccer players.  Often there is pain and stiffness that is worse on waking and when running. 

Gluteal tendon (side of hip)

Common in young females that are doing a lot of running or playing sport.  Also older women, especially around menopause or after post a hip injury / surgery.  Pain is often worse at night time, standing and walking.  There is some research showing a reduction in oestrogen can pre-dispose to tendinopathy. 

Hamstring tendon (back of hip)

Fast walkers, footballers, runners and people who do a lot of yoga are susceptible to hamstring tendinopathy.  They often experience pain on sitting, walking and bending forwards. 

What are the key risk factors for developing tendinopathy?

One of the biggest risk factors for a tendon injury is a past injury (2-19x greater risk of injury).

According to the research, people with tendon problems are not getting the rehabilitation and re-building of capacity they need.

Often patients self-discharge when their pain has gone away. 

It is imperative for the treating clinician to educate the patient that rehabilitation is a two step process:

1.  Reducing pain and then

2.  Re-building capacity in the tissues to match the demands placed on them

Other systemic conditions that can increase the risk of developing tendon pain include:

• Type 2 Diabetes ( 3 x risk)

• High cholesterol

• High blood pressure

• Menopause

• Obesity

• Inflammatory arthropathies

Some other factors that put you at a higher risk of ongoing tendon pain:

• unrealistic beliefs about likely healing time and optimal load management strategies

• inaccurate beliefs pain e.g. avoiding movement due to fear or rupturing a tendon

• too much passive treatment

• reduced variability of movement / exercise

How is a diagnosis made? 

Tendon issues are diagnosed with a combination of history and physical testing. 

If you have a localised pain that gets worse with movement and you can recall a sudden change in loading, there is a good chance you have a tendon problem.

Do I need a scan? 

Ultrasound scans can be useful to confirm the diagnosis and rule out certain other conditions. 

(See below for more info on scans)

Recovery and Management :

1.  Education ... (And Addressing Beliefs About Pain)

The long term goal is to create greater capacity in the tissues and this is your job, under the guidance of the physiotherapist looking after you.  

Manual therapy and dry needling does have a role to play in the short term to decrease pain and normalise muscle tone.

Credit: Jill Cook

Pain and Pathology

You may have a scary sounding ultrasound report, with words such as 'severely degenerative'.

The bad news first.  Your scans will most probably always look terrible. 

Structurally over time, there will be no change, despite what you do in terms of treatment.

The good news:

Many high quality research studies have shown that there is no correlation between pain and structural changes on scans. 

Your tendon will always be degenerated.

However, the thing we do have control over is the mechanical adaptation in the tissues around the tendon, as well as optimising biomechanics and sharing the load around the body.

The goal of treatment is to build the capacity in the tissues surrounding the tendon so that it meets the demand and creates a buffer zone of relaxation.

Some very important things to remember:

"Pathology is common in people without pain, so it cannot be the cause of pain.

Worse pathology does not mean it will be harder for you to get better.

Tendon pathology often does not change, even when the pain resolves" - Peter Malliaras
 

Recovery Time Line

It's important to understand the nature of recovery is often a case of 2 steps forward and 1 step back pattern. 

It's normal for your pain levels to fluctuate.

If you can accept this, while continuing with your rehab, you will have a much greater chance of success.

Credit: Adam Meakins

2.  Reduce the load temporarily while reducing pain and inflammation

Pain can be brought under control by managing load and using ice and NSAID's. 

You may need to take a short break from any aggravating activities.

If you can't take anti-inflammatories you may need to look at your diet for areas to address inflammation.

How can isometrics help decrease pain?

Isometric refers to a static contraction of a muscle without any movement. 

For example the diagram below shows an isometric contraction of the calf/achilles:

Benefits of isometric contractions in tendon healing (Malliaras et al 2013):

• Isometrics can decrease pain without adding excess load to the tendon.  

• time under tension can be maximized to allow greater tendon strain, which is a likely stimulus for tendon adaptation

• there is minimal soreness after doing isometrics, making them an ideal exercise 'during season'

• loading can be performed in a range that is not painful and tendon compression can be minimized

The positive research around isometrics is in it's early stages and mainly focuses around the patella tendon.

3. Assess current load capacity and tolerance then begin re-loading the tendon.

Your Physiotherapist will take you through a comprehensive load capacity assessment and then develop a re-loading strategy.

This most important factor is that we progress the load over time to bring out positive adaptation and improved load tolerance. 

You will most likely meet with your Physio once per week in the short term to closely monitor and progress the load at a suitable rate.

4.  Clean up biomechanical issues and kinetic chain deficits

Biomechanical issues that may need addressing:

• poor running technique

• over-pronation

• landing mechanics

• postural issues

Kinetic chain deficits that may need addressing:

• weak glutes

• weak calves

• weak quads

• weak hamstrings, adductors

• weak core

• excessively tight muscles and joint restrictions

We will address these factors in the clinic.  By optimising your movement efficiency, you will increase the likelihood of successfully returning to doing what you love and staying pain-free.

5.  Progress the load and build capacity to greater than demand and gradually ease back into sport / exercise

This is where you get to really to push the boundaries of building capacity and gradually resume training and getting back to what you love. 

It's important at this stage to think not only about training but also proper recovery to allow the tissues to optimally adapt. 

You will want to optimise things like sleep, food / protein intake and foam rolling to keep your muscles tuned up.

This stage may weeks / months to fine tune and this is where we will monitor you loads to ensure a successful return.

In Summary - 5 Take Home Messages:

1.  There Is Hope

Despite your ugly looking scan and long-term pain, there is good evidence to suggest you can make a good recovery and get back to doing what you enjoy.

2.  It Takes Time

Tendons are resilient and adapt.  But you need to give them time. 

The time-frame on average to achieve this is a minimum of 12 weeks (but continual small improvements can still occur up to 5 years later).

3.  Get Assessed By A Physiotherapist

There is a significant degree of complexity involved in a tendon problem and a Physiotherapist, after a comprehensive assessment will be able to guide you towards a positive outcome. 

4.  Only Exercise Can Increase Load Tolerance

"Your tissue capacity will only be as good as the load you put on it" - Professor Jill Cook

The end game is to build your resilience and capacity to create a 'buffer' zone of relaxation. 

5.  Think Quality Of Movement Before Quantity

Movement capacity develops step by step. 

Small mindful movement of the muscle-tendon complex can improve efficiency and help ensure that your tendon issue becomes a thing of the past.

This is where Pilates can be very useful. 

Pilates provides the perfect environment for sharpening the mind-muscle connection and also introduces elements of movement variability that help improve resilience.

Bonus Tips:

• PRP injections are a waste of time

• Steroid injections can have short term benefit but 12 months later can end up worse due to weakening of the tendon.

• Fast walking can cause hamstring issues

• For a tendon problem, generally it's best to avoid stretching

• Hip bursitis is treated with same strategies as gluteal tendinopathy

• Extracorporal Shockwave therapy is worth trying (more info about this click visit our friends at Adelaide Podiatry)

Thanks for reading this summary and if you have any questions or comments, please feel free to email dan@kinfolkwellness.com.au

If you have a tendon issue you would like to have assessed, I'd be honoured to help guide you.  

You can make a booking using our easy online system here.

How To Make Friends With Your Hamstrings

The hamstrings have a long history of being the 'enemy' of good movement.

Tight, painful, cramping and all around bad guy, the poor old hammy cops a lot of negative press.

In this blog post, I wanted to share my thoughts with you about how to make friends with the hamstrings so you can all get on well together. 

What are the hamstrings?

The hamstrings are made up of three muscles - the inside two are called the semimembranous and semitendinosus and the large outside hamstring is known as the biceps femoris. 

The back of a right leg from hip to knee

In a bigger contex:

The Superficial Back Line, from Thomas Myers Anatomy Trains

The hamstrings are part of the Superficial Back Line - which is a myofascial line of tissue that incorporates the muscles and fascia from the bottom of the foot up to the back of the head. 

When one area isn't functionally overly well, there will be compensations up or down the chain.  Ever heard of hamstring issues affecting your lower back? 

Tight hamstrings means that the instead of stretch and movement occurring through the back of the leg, the lower back gets compressed, especially when sitting or bending forwards. 

That is one of the reasons we take a holistic view of your body and movement when you come in for an assessment.  We leave no stone unturned in our quest to get to the source of your problem. 

It doesn't matter where you feel your symptoms, we don't chase pain.  We focus on finding the weak link/primary source and then allow your (powerful healing) body to do the rest.

"Where you think it is, it ain't" - Ida Rolf

What is the role of the hamstrings?

The primary role of the hamstrings in walking and running is to eccentrically control the landing of the foot.  The hamstring complex undergoes a substantial eccentric contraction during the late swing phase (Yu et al, 2008) of gait.

Eccentric refers to a type of contraction where a muscle lengthens while contracting vs a concentric contraction where the muscle in contracting and shortening (e.g. doing a bicep curl). 

As you can see, just before your foot lands, your knee is going from a bent position to an extended straight position and the hamstrings job is to allow for a controlled, smooth landing.

Whilst it is important to have adequate flexibility, the actual more important job of the hamstring to have enough strength and capacity to walk and run properly.

If a muscle doesn't have much capacity to contract when needed, it will most likely get overloaded.  When it gets overloaded, it's muscle fibers contract and knot up, limiting flexibility.

For a runner, strength and stability trumps flexibility everyday of the week.

Trigger points in the hamstrings can refer pain to the upper thigh, buttock and around the knee

3 Steps To Making Friends With Your Hamstrings:

1.  Stop stretching them. 

Never again do a standing hamstring stretch.  I don't mean avoid it for a few weeks or months.

I mean NEVER* do this stretch whilst you are alive on this planet! 

Like an addict, you gotta give it up cold turkey. 

Yes, you can still do yoga and downward dog and continue to move through functional range of movements but no mindless, static stretching. 

Stretching in this position, you are actually making the hamstring weaker

Hang on a sec...I thought stretching was a good thing!?

Stretching the hamstring in this position, you are actually making the hamstring weaker and sending confusing mixed messages to the brain about what the function of the muscle is. 

Anytime your brain is confused, it's going straight into fight-flight mode and will want to tighten everything up to protect it.

Intuitively stretching feels good and it often does give some short term relief. 

But in the long run, with continued stretching, the hamstring becomes weaker and more likely to become overloaded and tight.  Then you've got yourself into a real pickle. 

The hamstring, once locked down, becomes an inefficient blob that hampers everything you try and do.

Our first step in making friends with the hamstring is to stop pissing it off, so no more stretching. 

By the way, as an added bonus, your lower back pain and sciatica will thank you as the standing hamstring stretch has a good way of irritating it.

*If you desperately feel the need to stretch, then you can apply heat packs or use the foam roller/spiky ball directly on the muscle. 

2.  Reset.

To reset the hamstrings, I recommend first releasing the muscle with 3-4 sessions of deep tissue dry needling and myo-fascial release massage.  This is like pushing re-set on your muscle tone and creating a fresh slate to work with.  After a few sessions, the muscle will release and then we can move onto the final step.

It's important to get a twitch response that stimulates the blood flow and releases the chemicals in the muscle that have been holding it tight. 

Be prepared for some significant post-treatment soreness for a 1-2 days.  Months/years/decades of tightness ain't going down without a fight!

Check out more about dry needling here and see how it can get your healing on the fast track. 

3.  Build 'Em Back Up.

The biggest issue around the hamstring is it's near universal lack of strength. 

When was the last time you did a specific hamstring strengthening exercise? 

Most of us tend towards an excessive quads/hip flexors vs hamstrings ratio due to excess sitting, walking and running. 

Quads are strong, hammies weak.

This imbalance is perceived by the hamstrings as threatening. 

Powerfully contracting the quads during the running and kicking motion could potentially damage the hamstring. 

How does the brain / muscle respond to threat? 

You guessed - it tightens up.

Graduated Strengthening Program For Hamstrings:

The best long term strategy to make friends with your hamstrings is to build capacity so they can perform their job of eccentrically controlling the foot in landing.

If the hamstrings can happily do their job, they'll most likely start to feel safe, protected and will naturally start to release all on their very own. 

Trust me, I'm a Physiotherapist!

It will take time (3-6 months) to build strength, so listen to your body and take it easy at the start.  If you can only manage 2-3 reps in the beginning, that is fine.  No rushing!

The goal is to push the hamstring to fatigue (feeling some hamstring soreness the following day is a good sign) and then allow it to adapt, recover and get stronger. 

Make sure you create the right environment for healing via eating well (protein + vegies), drink plenty of water and get enough sleep.

Aim to do these strengthening exercises twice per week.

How many reps? 

If you figure every 10k your run is approximately 5,000 steps on each side, then the hamstring needs a fair amount of endurance capacity.  I would keep gradually increasing the reps until you are not feeling any pain on your walks and runs.

Quick note: avoid the hamstring curl machine at the gym.  This exercise strengthens and shortens the hamstring, which is what you don't want.

Step 1: Bridge

Try 3 x 30 sec holds.  Relax your lower back and squeeze your glutes. 

Tuck your pelvis so you feel the opening of the front of the hips. 

Keep the bridge high as you extend one leg in front. 

Hold for one breath and then switch sides.  When you can repeat x 10 each side, move to step 2.

Step 2: Bridge on Foam Roller

Make sure the roller isn't too far away from you, otherwise the hamstrings will cramp.  

The goal is to gradually build up the strength in the hamstrings.  It may take 3-6 months so no rushing. 

If you push too hard, then you most likely will lock the muscle down and you'll have to start over.

When you can complete 3 x 10 reps on each side, move onto step 3.

Step 3: Hamstring Curls on Swiss Ball

The perfect Eccentric Hamstring Exercise: Strengthening AND lengthening.

Quickly pull the ball in towards you and then SLOWLY (slow as you can) lower the ball away from you. 

Count to as least 5 seconds as you do this. 

Repeat until fatigue. and then do another x 2 rounds. 

If you can do x 30 reps pretty easily, try one legged.

Practicing this movement will have a direct improvement on your hamstring problems, especially for runners.

Step Four: Single Leg Deadlift

Hold a dumbbell in each hand and stand on your right leg, lifting your left leg a few inches behind you (a). Keeping your back straight, lean forward from your hips until your body is almost parallel to the floor, the weights in line with your shoulders (b). Return to start.  Do 12, then switch legs.

Bonus Tip:

Don't forget to strengthen the glutes, lower back and calf muscles above and below the hamstring.  Often if these muscles have reduced capacity, the hamstring can become overloaded and then lock down. 

So there you have it.

Have a go and please write in the comments how you get on.

I'd really appreciate your feedback :-)

References:

Hamstring muscle kinematics and activation during overground sprinting.

Yu B, Queen RM, Abbey AN, Liu Y, Moorman CT, Garrett WE. J Biomech. 2008 Nov 14;41(15):3121-6

3 Tips To Running Without Knee Pain

Knee pain is really common among runners (about 40% will experience in a given year). 

So...rather than ignoring it and hope its goes away...here are 3 simple tips to help you keep your knees tracking smoothly and efficiently :

1.  Increase your cadence

Research suggest a small increase in your cadence (increasing step frequency by 5%) leads to a decrease in ground reaction force. 

Essentially, shortening your stride takes the stress off your legs and taps into your 'spring system' that is more efficient and less impact on your knees. 

The average runner's cadence is approx 160 steps per minute, and the research shows increasing to 170-180 can make a big difference.

Be warned though, this style of running will put a greater load on your cardio-vascular system - so you may need to keep an eye on your heart rate and take breaks as needed.

Download free Metronome App here

Some GPS watches track your cadence.

Otherwise you can download a free metronome to help you.  I like to use the metronome for a few minutes at the start of a run to help get my rhythm in place...starting at 170bmp and then up to 180bmp for a few minutes.

2.  Strengthen your glutes

"Strong glutes makes everything better" - Perry Nickelston

The glutes are the main protectors of the knee.  When they become weak or inhibited they allow excess pressure on the knee joint and the muscles that surround it such as the ITB. 

When running, the glutes should take most of the load.   The gluteus maximus is the biggest and most powerful muscle in the body.  But in the presence of pain, injury or excessive sitting it 'switches off' and other muscles are forced to compensate.

Here are some of our favourite exercises to get your glutes back online and functioning:

• clam

• bridge

• single leg bridge

• reverse lunge

• squats

• split squats

If you think your glutes might need some work...then you should join our weekly Pilates class...click here to reserve your place (spots are limited). 

Bridge:  Tuck the pelvis under lift your hips - look for a straight line between knees, hip and shoulders.  Breathe and relax the shoulders.  Hold for 1 minute x 3 sets.

3.  Foam roll AFTER you run

The muscles in your legs have to work pretty damn hard during a run - absorbing up to three times your body weight every time you land. 

Muscles such as the outer quads, ITB, calf, hamstrings and adductors can get tight and knotted up and have a lot of trouble relaxing back to 'normal' after a hard run. 

This tightness can lead to increased pressure on the patella (knee cap) and cause ongoing tracking issues with the knee. 

A quick full body tune-up can be completed in less than 90 seconds (see video below) and help iron out tight spots around the knee.  

Of course, if you are tight in a particular area, you should spend longer working out the knots.

Is Pain or Injury keeping you from being as active and healthy as you want?

Why Knee Pain Gets Worse With Lunges And How To Ease It

The Resilient Knee Project is an innovative solution for people with chronic knee pain that empowers individuals to self-manage their pain and most importantly, get them back to enjoy the physical and mental benefits of running.

Founded by Daniel O’Grady, dedicated professional with first hand experience of overcoming knee pain and running the NYC Marathon, the project aims to be a world leader in restoring people’s confidence in their knees and get back to doing what they love.

Is The Resilient Knee Program right for you?

Start a conversation with our new Chat Bot HERE

Why knee pain gets worse with lunges and how to ease it

Knee pain while performing lunges is very common and every day in the clinic I hear people say that performing lunges aggravates their knees. 

I find my patients either:

1. Push through the pain and keep going with them, ending up with an injury or

2. Stop doing them altogether and miss out on the many benefits lunges can bring.

In this post, I will show you how performing lunges can place excessive stress on the knee and a give you a simple way to avoid this from happening. 

What happens during a typical lunge?

See the picture above where the front knee travels along way forward past the ankle.

This is not a problem if you don't have knee pain. 

BUT, if you do have knee issues, there is a high chance this movement will aggravate your pain.

Doing a forward lunge in this manner plays into a common muscle imbalance that many of us suffer from - over-active quadriceps and hip flexors at the expense of the gluteals. 

Walking lunges are particularly bad at encouraging this quads dominance, as the center of gravity is traveling in forwards direction.

Quick anatomy review:

The hip flexors (left) that attach the lower back to the hip and the quads (right) that attach the hip to the knee. 

The effect of over-loaded quads:

Due to the fact that we are sitting, driving and walking a lot, our quads and hip flexors are naturally prone to tightness and overuse. 

Adding further stress in the form of lunges can push them over the edge.

When a muscle is repeatedly contracted in a shortened position, eventually this will lead to development of knots or trigger points in the muscles fibers. 

This reduces the flexibility in the muscle and also gives rise to referred pain, that often is felt in the knee.

Referral pattern of the quads:

When the quads develop trigger points (knots in the muscle fibers) they have a characteristic referral pattern. 

See below:

So....instead of the forwards lunge, try this simple but powerful change:

The Reverse Lunge

To obtain the benefits of a lunge, without putting your knees at risk, follow these 3 steps:

Step 1:

Maintain a neutral spine (think gently tucking the pelvis under and activating the core muscles) and then taking a big step back. 

You should feel a gentle stretch in the front of the leg that steps back (upper quads and hip flexors). 

Tip > you can use a foam roller to counter balance the backwards motion.

Step 2:

The key to the reverse lunge is maintaining a vertical tibia in the front leg.

At the bottom of your reverse lunge, take a quick look at your tibia bone (lower leg from knee to ankle) and it should be in a vertical position i.e. perpendicular to the ground. 

Keep your center of gravity back and over your hips. 

In this position, your glutes should be activating strongly.  The quads should also be working, but not excessively. 

The nice thing about the reverse lunge is that if you push back to far, you will only work the glutes harder, which is never a bad thing.

Progression: Reverse Lunge with medicine ball

Step 3:

Push yourself back up to the start position using your glutes to lift yourself forwards.

If you can do ten on each side without much trouble, adding some weight in the form of a medicine ball or kettlebell is a great idea. 

Aim to complete three rounds.

Between sets you can do some bridges or step ups which will also target the gluteal muscles.

If you're sore in the glutes the next day, you know that you're on the right track!

Please have a go and let me know how you get on in the comments below.

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